Journal of thoracic disease · 2026
Diagnostic evaluation of pleural effusion in patients with non-small lung cancer affects time to diagnosis and treatment initiation.
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Lin Julie, Shojaee Samira, Ali Basim, Bassett Roland, Ost David, Grosu Horiana
Аннотация
BACKGROUND: Malignant pleural effusion (MPE) is a common complication in patients with non-small cell lung cancer and often signifies advanced disease. Timely diagnosis of MPE is critical for initiating appropriate therapy; however, cytologic analysis from thoracentesis has limited sensitivity, which often results in diagnostic delays due to the need for repeat procedures. We sought to identify factors associated with these delays.
METHODS: We conducted a multicenter retrospective cohort study of adult patients (≥18 years) with presumed or confirmed non-small cell lung cancer and no radiographic evidence of distant metastasis who underwent their first diagnostic intervention for a pleural effusion (either thoracentesis or pleuroscopy). The primary outcome was time from the initial diagnostic pleural intervention to initiation of cancer treatment. Linear regression was used to evaluate associations between clinical variables and diagnostic/treatment delays.
RESULTS: A total of 136 patients were included. Factors associated with delays from first pleural intervention to treatment initiation included final pathologic stage, the cytologic/histopathologic diagnosis at the first intervention, and number of interventions. Patients who did not receive a diagnosis at the first intervention experienced an average delay of 14.9 days compared with those diagnosed with malignancy at the first intervention. Each additional intervention was associated with a 19.4-day increase in time to treatment initiation. Similarly, time to definitive diagnosis increased by 24.5 days per additional intervention. Patients with a prior cancer history experienced an average delay of 13.9 days. Eastern Cooperative Oncology Group (ECOG) scores 1 or 3 were associated with shorter diagnostic delays compared with scores of 0 or 2.
CONCLUSIONS: Diagnostic delays in patients with non-small cell lung cancer and pleural effusion are significantly influenced by the results of the initial intervention and the need for repeat procedures. Earlier use of definitive diagnostic modalities such as pleuroscopy may be associated with reduced time to diagnosis and treatment initiation, particularly in patients with a high clinical suspicion of MPE.
METHODS: We conducted a multicenter retrospective cohort study of adult patients (≥18 years) with presumed or confirmed non-small cell lung cancer and no radiographic evidence of distant metastasis who underwent their first diagnostic intervention for a pleural effusion (either thoracentesis or pleuroscopy). The primary outcome was time from the initial diagnostic pleural intervention to initiation of cancer treatment. Linear regression was used to evaluate associations between clinical variables and diagnostic/treatment delays.
RESULTS: A total of 136 patients were included. Factors associated with delays from first pleural intervention to treatment initiation included final pathologic stage, the cytologic/histopathologic diagnosis at the first intervention, and number of interventions. Patients who did not receive a diagnosis at the first intervention experienced an average delay of 14.9 days compared with those diagnosed with malignancy at the first intervention. Each additional intervention was associated with a 19.4-day increase in time to treatment initiation. Similarly, time to definitive diagnosis increased by 24.5 days per additional intervention. Patients with a prior cancer history experienced an average delay of 13.9 days. Eastern Cooperative Oncology Group (ECOG) scores 1 or 3 were associated with shorter diagnostic delays compared with scores of 0 or 2.
CONCLUSIONS: Diagnostic delays in patients with non-small cell lung cancer and pleural effusion are significantly influenced by the results of the initial intervention and the need for repeat procedures. Earlier use of definitive diagnostic modalities such as pleuroscopy may be associated with reduced time to diagnosis and treatment initiation, particularly in patients with a high clinical suspicion of MPE.